Emphysema: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Prevention and Outlook

illustration of Emphysema


The lungs are important organs in the body. These are responsible for the oxygen and carbon dioxide exchange, which is vital for survival. If there is no oxygen in the body,
the cells will die, leading to hypoxia.

The lungs are sponge-like structures that are situated inside the chest and protected by the ribcage. Air passages make up the respiratory system and the smallest ones end in tiny air sacs, where the exchange of oxygen and carbon dioxide happens. The oxygen will be transferred into the bloodstream and in exchange, the carbon dioxide, which is the product of the chemical reactions in the body.

After repeated and prolonged exposure to certain chemical irritants, like cigarette smoke, the air passages and sacs will become inflamed. In the long run, the damage is inevitable. Normally, to accommodate the amount of air inhaled into the lungs, the air sacs and airways are elastic. However, when there is prolonged damage and irritation, the sacs,
as well as the airways, lose their elasticity, making breathing difficult.

However, many diseases could affect the respiratory system, like a group of lung diseases that belong to Chronic Obstructive Pulmonary Diseases (COPD). One condition is called emphysema.

Emphysema is a lung condition wherein the air sacs or alveoli in the lungs become damaged and inflamed. As a result, the walls of the sacs become weak and in time, they might rupture, leading to bigger air spaces than many small ones. In the long run, this will reduce the amount of oxygen that reaches the cells of the body. Also, will decrease the area of the lungs to fill with air.

Emphysema is caused by cigarette smoking and prolonged exposure to some industrial air pollutants or dust. In some cases, the condition is caused by a genetic disorder.


Patients with emphysema may leave the condition unnoticed for many years since they do not experience any sign or symptom. However, the main symptom of emphysema is shortness of breath, which can progress slowly. Another early sign is coughing, particularly during exercise or physical exertion.

Individuals with the condition may start avoiding activities that cause them to have the difficulty of breathing. Emphysema may even cause shortness of breath even of the patient is at rest.

The other symptoms include exhaustion, fast heartbeat, depression and unexplained weight loss. The signs of hypoxia or the lack of oxygen in the body include having bluish-gray fingernails or lips but this should be treated immediately to prevent dangerous and life-threatening complications.

In the later stages of the disease, the patient may have:

  • Emphysema chronic cough
  • Recurrent lung infections
  • Too much production of mucus
  • Wheezing
  • Anorexia and weight loss
  • Sleep problems
  • Cyanosis, due to the lack of oxygen
  • A morning headache due to the lack of oxygen
  • Extreme weakness or fatigue
  • Barrel-shaped chest due to the expansion of the ribcage to compensate with the enlarged lungs


The main cause of emphysema is the long-term exposure to airborne lung irritants such as:

  • Tobacco or cigarette smoke
  • Marijuana smoke
  • Chemical fumes
  • Dust
  • Air pollution
  • Smog

In rare cases, emphysema can be caused by a genetic condition of a protein that helps protect the elastic structures in the lungs. Dubbed as the alpha-1-antitrypsin deficiency emphysema, this condition runs in the family.

Cigarette smoke and emphysema

Cigarette smoking is by far the most common cause of emphysema. Fortunately, this is a preventable cause. This means that stopping smoking or not smoking in the first place can reduce the risk of developing emphysema.

Cigarette smoke can affect the lungs in two ways – it destroys the lung tissue and irritates the airways. The chemicals in cigarette smoke destroy the lung tissue and may result in the obstruction of air flow into the lungs. The harmful chemicals affect lung tissue in many ways. It affects the cells that clear mucus and other secretions in the airways and it temporarily alters the action of the cilia, which are tiny hairs that line the airways. Prolonged exposure to cigarette or tobacco smoke may cause the disappearance of the cilia and as a result, the person cannot clear out mucus secretions from the lower respiratory tract. This may increase the risk of recurrent lung infections.

Also, cigarette smoke may lead to the inflammation and irritation of the airways, which could also lead to airflow blockage. In the lungs, there are immune cells that combat infection. These are also affected by cigarette smoke and they may cause inflammation when there is a constant threat to the respiratory tract like the presence of bacteria.

In the long run, there would be consistent inflammation and enzymes would be released, leading to protein loss. This would lead to an altered elasticity of the alveoli.

4Risk Factors

Many factors may also increase the risk of developing emphysema, including:

Cigarette smoking – Aside from being a direct cause of emphysema, cigarette smoking may also increase the risk of a person in developing emphysema. This condition is most likely to develop in smokers. The risk increases depending on the number of years and amount of cigarette smoked.

Age – Older age is a risk factor for emphysema since lung function usually declines with age. Despite the fact that lung damage develops gradually in those with emphysema, most individuals with this condition begin to experience the symptoms between the ages of 40 and 60.

Gender – Men are more likely to develop emphysema than women. Though the reason for this is still unclear, the differences between both genders regarding hormones are suspected.

Exposure to secondhand smoke – People who are exposed to secondhand smoke may increase the risk of emphysema.

Exposure to occupational dust or fumes – When a person works in an environment where there are fumes from chemicals like wood, mining products, grain and cotton, they have a heightened risk of having emphysema in the future.

Exposure to air pollution – Inhaling pollutants like fuel fumes, car exhaust and other contaminants in the air may increase the risk of emphysema.


When emphysema is left untreated, it may lead to serious complications, including:

Pneumonia – This condition is caused by an infection in the bronchioles and alveoli.
An individual with emphysema is susceptible to pneumonia.

Pneumothorax – Pneumothorax is the condition wherein the lung will collapse. This is a life-threatening condition, especially for those with severe emphysema.

Heart problems – Emphysema may also heighten the likelihood of having heart problems, particularly the increased pressure in the arteries connecting the lungs and the heart.
This may lead to a condition called cor pulmonale, wherein a part of the heart dilates, expands and weakens.

Bullae or large holes in the lungs – Since the lungs become inelastic and weak, some people with emphysema may have empty spaces in the lungs. These large holes may decrease the amount of space available for the lung to expand. When there are huge holes in the lungs, this may increase the risk of lung collapse (pneumothorax) and atelectasis.


The doctor will initially conduct a complete physical examination and interview the patient about the symptoms and medical history. If the patient never smoked, he may be asked about the exposure to other chemicals or secondhand smoke. Also, the patient may also be tested for a α1-antitrypsin deficiency, which can also lead to emphysema.

For further testing, the doctor may recommend the following:

Imaging tests

The doctor will request for imaging tests. A chest X-ray can provide a picture of an advanced emphysema. Moreover, it helps in ruling out other possible causes of difficulty in breathing. However, in some cases, this test may also show normal findings despite the person having emphysema.

A better test to use is the computed tomography or CT scan, wherein cross-sectional images are taken of the internal organs, including the lungs. This test can be used to scan if the patient can be treated via surgery.

Lung function tests

Lung function tests are utilized to confirm a diagnosis or emphysema, to examine the response to various treatments and to monitor or prevent disease progression. These tests also help measure the capacity of the lungs regarding their function as the exchange of respiratory gases.

One of the most common lung function tests is the spirometry, which assesses the obstruction of airflow into the lungs. It measures this by taking the levels of the decreased forced expiratory volume after treatment.

Laboratory tests

The doctor may also request for some laboratory tests to see the ability of the lungs to transfer oxygen into the body and remove carbon dioxide from the bloodstream.


Emphysema, as well as the other COPDs, cannot be cured. However, the treatment of these conditions aims to stabilize the condition, prevent complications, relieve the symptoms and slow the progression of the disease. There are various treatment options used, including:


Drugs are available to minimize the symptoms depending on the severity of the symptoms.

The doctor may prescribe bronchodilators to relieve difficulty in breathing and coughing by relaxing the airways, inhaled steroids to reduce inflammation, and antibiotics to fight bacterial infections linked to emphysema such as pneumonia or bronchitis.


In some cases, the doctor may recommend surgery to treat emphysema. A lung transplant is used if there is severe lung damage and all other options are ineffective. Moreover, a lung volume reduction surgery is done to remove small parts of damaged lung tissue. This procedure will help expand the lungs and improve breathing.


Therapies are also available to provide relief of symptoms. These include pulmonary rehabilitation, oxygen therapy, and nutrition therapy. Pulmonary rehabilitation is a program used to teach patients of breathing exercises to reduce shortness of breath and boost energy levels to improve the ability to exercise.

On the other hand, oxygen therapy is when oxygen is introduced into the body regularly to improve oxygen levels. Lastly, nutrition therapy is done to promote overall well-being among patients with emphysema and to regulate the weight, depending on the stage of the disease.


The best way to prevent emphysema is to stop smoking or avoiding smoking. Other ways that may help reduce the chances of COPD is through vaccination against pneumonia and influenza. Also, getting the best nutrition is important. When there is reduced lung capacity, the patient may have a nutritional deficiency and weight loss. It is important to properly have a healthful diet.


The outlook for people with emphysema may vary based on the disease’s severity.
There is no cure for the condition and in time, it may get worse. However, patients can slow the progression of the disease through proper diet, management of the symptoms and avoiding smoking or exposure to chemical fumes.